CCFP priority topic 69 of 105
Newborn on the CCFP exam
7 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 7 key features for Newborn. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 7
Small anomalies
Examine every newborn head to toe for small anomalies that can point to others.
CFPC skill Clinical reasoningPhase Hypothesis generation, physicalSources Choosing Wisely Canada, Canadian Paediatric Society
On the exam
A well baby has a small skin tag in front of one ear. Expect a short menu (pick several from a list) of findings to look for.
Pick the findings that matter.
Common mistakes
Stopping the exam once the tag is found, or ticking normal birthmarks as anomalies. Or calling a dimple with a hair tuft above it normal.
Approach
- Examine in the same order every time: skull, face, ears, palate, neck, chest, belly, hips, spine, genitals and anus. Record the exam, with head size and length.
- Treat one small finding as a reason to look harder. A pattern of findings, not one alone, points to a syndrome.
- Blue-grey patches and a pink patch on the neck are birthmarks. They are normal variants, not anomalies.
- A midline dimple low in the cleft, near the tailbone, in a well baby needs no imaging.
- Image the spine if the dimple or a sinus (a small tract) sits above the cleft. Image too if there is a hair tuft, a hemangioma (a vascular birthmark), a skin tag or a lump.
| Finding | What it means | Action |
|---|---|---|
| Midline dimple low in the cleft, near the tailbone, nothing else | Common, normal variant | No ultrasound or MRI |
| Dimple or sinus above the cleft | Possible hidden spinal defect | Image the spine |
| Any dimple with a hair tuft, hemangioma, skin tag or lump | Possible hidden spinal defect | Image the spine |
Key feature 2 of 7
Sepsis can look mild
When a parent or nurse is worried about a newborn, suspect infection and look for quiet signs.
CFPC skill Clinical reasoning, selectivityPhase Hypothesis generation, physical, history, diagnosisSources Canadian Paediatric Society
On the exam
A nurse calls: a 30-hour-old baby is sleepy and feeding poorly. Expect a short menu (pick several from a list) of tests.
Pick the tests to send tonight.
Common mistakes
Calling it a latch problem or jaundice and waiting. Or sending gastric, skin surface or urine cultures, which are not recommended in a newly born baby.
Approach
- Treat a worried nurse or parent as a clue. Early signs of sepsis in a newborn may be subtle.
- Look for breathing trouble, a temperature too high or too low, a fast heart rate, floppiness, sleepiness, poor colour or circulation, and seizures.
- A low temperature counts. A baby below 36.0°C is managed like a baby with fever.
- Ask about risk. Was the mother GBS (group B strep) positive? Were membranes ruptured 18 hours or more? Was her fever 38°C or more? Did a past baby have GBS disease?
- Unwell baby: blood culture and complete blood count (CBC), a lumbar puncture, and a chest X-ray if breathing is affected.
- Start ampicillin plus an aminoglycoside (a class of intravenous antibiotic). A normal C-reactive protein (CRP) should not delay antibiotics in a baby with signs.
| Test | Use it? | Why |
|---|---|---|
| Blood culture and CBC | Yes | The culture is the gold standard. Draw the CBC at the same time. |
| Lumbar puncture | Yes, if signs of sepsis | Always if the blood culture grows. Can wait if the baby is unstable. |
| Chest X-ray | If breathing signs | Looks for pneumonia. |
| CRP | Not on its own | A normal value does not delay antibiotics. |
| Gastric aspirate, skin surface and urine cultures | No | Not recommended in a newly born baby. |
Key feature 3 of 7
Resuscitation
Run a newborn resuscitation by the current Canadian program, step by step.
CFPC skill Clinical reasoning, procedure skillsPhase TreatmentSources Canadian Paediatric Society
On the exam
A limp, blue baby is not breathing at birth. Expect one best answer for the next step.
Pick the first action.
Common mistakes
Waiting 60 seconds on the cord for a baby who is not breathing, when your centre cannot resuscitate with it intact. Or skipping warmth while you start breaths.
Approach
- Follow the current Neonatal Resuscitation Program (NRP) algorithm, step by step.
- Before the birth, ask about risk. Check the warmer, suction and bag and mask, and give each person a role.
- A term baby who breathes and cries needs no help. Defer cord clamping for 60 seconds. Keep the baby warm in towels or on the mother while you wait.
- A baby who needs resuscitation now comes first. Do not wait on the cord unless your centre is equipped to resuscitate with it intact.
Key feature 4 of 7
Keeping skills
If you deliver babies, keep your newborn resuscitation training current.
CFPC skill ProfessionalismPhase Treatment
On the exam
A rural family physician attends births now and then. Expect a short menu (pick several from a list) of ways to stay ready.
Pick how to keep skills ready.
Common mistakes
Counting on the course passed in residency, or on a paediatrician arriving in time. Skills you rarely use fade.
Approach
- If births are part of your work, keep your Neonatal Resuscitation Program (NRP) status current, as your hospital and college require.
- Practise mock births and resuscitations with the nurses you work with. Babies are resuscitated by teams.
- Know your unit's equipment: the warmer, suction, and a bag and masks in sizes for term and preterm babies.
- Know who to call for help and for transfer, and how long they take to arrive.
- If you do not attend births, say so. Know how to keep a baby warm and breathing until help comes.
Key feature 5 of 7
Formula feeding
Back a parent's choice to formula feed without judging it.
CFPC skill Professionalism, patient-centred approachPhase TreatmentSources Canadian Paediatric Society
On the exam
A young mother decides to formula feed. A nurse asks you to change her mind. Expect one best answer.
Pick the best response.
Common mistakes
Restating the benefits of breastfeeding, or offering a trial week, after she has chosen. Treating her choice as a problem to fix is pressure, not support.
Approach
- Accept an informed choice. Canadian paediatric guidance promotes breastfeeding and also says mothers should feel supported in their own feeding choices.
- Do not repeat the benefits once she has chosen. It reads as judgement and can push her away from care.
- Teach safe formula feeding: which formula, how to prepare it, how much and how often, and how to tell the baby is feeding well.
- Before discharge, record at least two good feeds. If weight loss nears 10% of birth weight, check feeding before the baby goes home.
- Keep the door open. She can change her mind, and you will help either way.
Key feature 6 of 7
Checks that come later
Re-examine a newborn over time for problems that only show up later.
CFPC skill Clinical reasoningPhase Follow-up, physicalSources Canadian Paediatric Society
On the exam
A well term baby, 20 hours old, is going home early. Expect one best answer for the heart screen.
Pick how and when to screen.
Common mistakes
An echocardiogram (heart ultrasound) or four-limb blood pressures in place of the screen. Or skipping it because the prenatal scan was normal and there is no murmur.
Approach
- Screen every well term and late preterm baby (34 weeks or more) with pulse oximetry between 24 and 36 hours after birth. Use the right hand and either foot.
- A fail needs a full assessment and a paediatrician. If a heart cause is likely or unclear, refer to cardiology for an echocardiogram (heart ultrasound).
- A normal prenatal scan and no murmur do not rule out critical heart disease. Both miss cases, so every baby is screened.
- Going home before 24 hours: arrange the screen at 24 to 36 hours, by a return or home visit. An early screen beats none.
- Make sure the hearing screen is done or booked before discharge. Check the result at follow-up.
- Check the hips for a hip that slips out (Ortolani and Barlow tests) at birth and at later visits. Note risk factors for hip dysplasia.
| Result | Reading | Next step |
|---|---|---|
| Pass | 95% or more in both limbs, and a gap of 3% or less | Routine care |
| Borderline | 90 to 94% in either limb, or a gap over 3% | Repeat in 1 hour. A third borderline result is a fail. |
| Fail | Below 90% in either limb | Full assessment, paediatrician, cardiology if a heart cause is possible |
Key feature 7 of 7
Going home
At discharge, teach parents what danger looks like and agree where they will go.
CFPC skill Clinical reasoning, communication, patient-centred approachPhase Treatment, follow-upSources Canadian Paediatric Society
On the exam
A baby treated for sepsis is ready to go home. Expect a short menu (pick several from a list) of discharge advice.
Pick the warning signs and the plan.
Common mistakes
Telling parents to book an office visit for poor feeding or sleepiness, or to wait for a fever. Those signs need assessment now, fever or not.
Approach
- Book a check with a named provider 24 to 72 hours after discharge. It can be in clinic, in hospital or at home.
- Teach the early signs of illness: jaundice and signs of dehydration. Teach breathing trouble, a baby too sleepy or floppy to feed, and a temperature too high or too low.
- Fever is a rectal temperature of 38.0°C or more. Below 36.0°C counts too. In the first 28 days, either one needs urgent assessment and tests.
- Parents of a baby at risk of infection must know its signs and when to get help.
- Give a written record: results, including bilirubin, the follow-up plan, and who to call.
- Make the plan with them: who to call at night, where to go, and how they will get there.
Flashcards
Answer it first, then check.
KF 1A well baby has a midline dimple low in the cleft. Do you image it?
No. Image only with a hair tuft, a dimple or sinus above the cleft, a hemangioma, a skin tag or a lump. Source: Choosing Wisely Canada
KF 2Name four risk factors for early-onset sepsis in a term baby.
Any four: maternal GBS, GBS in her urine, a past baby with GBS disease, membranes ruptured 18 hours or more, maternal fever 38°C or more. Source: Canadian Paediatric Society
KF 2Which cultures do you skip in a newly born baby with possible sepsis?
Gastric aspirate, skin surface and urine cultures. Send a blood culture and CBC, and do a lumbar puncture. Source: Canadian Paediatric Society
KF 3A healthy term baby cries at birth. When do you clamp the cord?
After 60 seconds. Deferred clamping improves blood counts at birth and beyond. Source: Canadian Paediatric Society
KF 5A formula-fed baby has lost almost 10% of birth weight. What before discharge?
Assess how feeding is going. Weight loss near 10% means checking feeds before the baby goes home. Source: Canadian Paediatric Society
KF 6Pulse oximetry reads 92% in the foot and 96% in the right hand. Next step?
Repeat in 1 hour. A reading of 90 to 94%, or a gap over 3%, is borderline. Source: Canadian Paediatric Society
KF 6Discharge is planned at 18 hours. What about the heart screen?
Arrange it at 24 to 36 hours, by a return or home visit. An early screen beats none. Source: Canadian Paediatric Society
KF 7When should a healthy term baby be seen after leaving hospital?
By a named provider 24 to 72 hours after discharge, in clinic, hospital or at home. Source: Canadian Paediatric Society
FAQ
Which resuscitation guideline does the exam follow?
In Canada, newborn resuscitation is taught through the Neonatal Resuscitation Program, run by the Canadian Paediatric Society. Know its algorithm well; the exam follows it.
Does a baby with sepsis always have a fever?
No. Early signs may be subtle, and a newborn may run cold instead. The Canadian Paediatric Society manages a temperature below 36.0°C the same way as a fever.
How do you take a newborn's temperature?
Rectally. It is the reference standard, and fever is 38.0°C or more. Armpit, mouth and ear readings do not reflect core temperature well in young babies.
Does a normal newborn exam rule out heart disease?
No. Some critical heart lesions show no signs before discharge, and a prenatal scan misses many. That is why every term and late preterm baby gets pulse oximetry screening as well.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Choosing Wisely recommendationsChoosing Wisely Canada
- Position statements and practice pointsCanadian Paediatric Society